Feature Article 

Strategies to Overcome Barriers to Pneumococcal Vaccination in Older Adults: An Integrative Review

Julie A. Koch, DNP, RN, FNP-BC

Abstract

Health care systems and policy changes have been critical in increasing pneumococcal vaccination rates to current levels. Still, numerous barriers to immunization persist. To assist clinicians caring for older adults, an integrative review of the literature was performed to examine interventions demonstrating efficacy in office settings. Within the 11 studies reviewed, immunization rates increased consistently when health care systems supported organizational changes in clinical procedures and staffing. Data supporting the use of provider reminders were inconsistent, but the availability of information technology to generate reminders and access clinical guidelines modestly increased vaccination rates. Patient reminders (telephone or mail) demonstrated efficacy in multiple studies. Not surprisingly, the literature also supported the nurse’s role in enhancing vaccination rates. Findings of this review support the need for sustained organizational change; implications for clinical practice are apparent. Advanced practice nurses can assume leadership roles within change processes as the nation transitions to electronic medical records.

Authors

Dr. Koch is Adjunct Assistant Professor, Valparaiso University College of Nursing, Valparaiso, Indiana.

The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. The author thanks Carole A. Pepa, PhD, RN, for her support and guidance during initial manuscript development.

Address correspondence to Julie A. Koch, DNP, RN, FNP-BC, Adjunct Assistant Professor, Valparaiso University College of Nursing, 836 LaPorte Avenue, Valparaiso, IN 46383; e-mail: .Julie.koch@valpo.edu

10.3928/00989134-20110831-03

Health care systems and policy changes have been critical in increasing pneumococcal vaccination rates to current levels. Still, numerous barriers to immunization persist. To assist clinicians caring for older adults, an integrative review of the literature was performed to examine interventions demonstrating efficacy in office settings. Within the 11 studies reviewed, immunization rates increased consistently when health care systems supported organizational changes in clinical procedures and staffing. Data supporting the use of provider reminders were inconsistent, but the availability of information technology to generate reminders and access clinical guidelines modestly increased vaccination rates. Patient reminders (telephone or mail) demonstrated efficacy in multiple studies. Not surprisingly, the literature also supported the nurse’s role in enhancing vaccination rates. Findings of this review support the need for sustained organizational change; implications for clinical practice are apparent. Advanced practice nurses can assume leadership roles within change processes as the nation transitions to electronic medical records.

Dr. Koch is Adjunct Assistant Professor, Valparaiso University College of Nursing, Valparaiso, Indiana.

The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. The author thanks Carole A. Pepa, PhD, RN, for her support and guidance during initial manuscript development.

Address correspondence to Julie A. Koch, DNP, RN, FNP-BC, Adjunct Assistant Professor, Valparaiso University College of Nursing, 836 LaPorte Avenue, Valparaiso, IN 46383; e-mail: .Julie.koch@valpo.edu

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